“After the operation, I feel stronger and my chest is much better. Thank you doctor for giving me new hope!” It was a special day for my aunt, who was fortunate to be the beneficiary of the first cardiac contractility regulator (CCM) in Zhejiang Province. The team of Professor Xiang Meixiang of the Second Affiliated Hospital of Zhejiang University School of Medicine implanted CCM for her, which marks that the treatment of heart failure in Zhejiang Province has entered a new stage.
Aunt Liu is 76 years old and has been suffering from chest tightness and shortness of breath for 10 years. At first, she was just struggling to keep up with her energy, and her chest was tight and short of breath from time to time. She went to the hospital for an examination and found that her “heart was enlarged”, but she didn’t care about it at the time, thinking that it would be fine to rest more. However, in the past 7 years, her physical strength has been getting worse and worse. After a little exercise, she feels chest tightness and shortness of breath, and is often accompanied by edema of both lower extremities. The recent hospital examination found that the index of cardiac function “ejection fraction” (EF value) has decreased significantly. In bad times, the EF value is only 15% (normal EF value is more than 50%). Although receiving standardized drug treatment to improve, Aunt Liu was repeatedly hospitalized due to chest tightness and shortness of breath, and her quality of life plummeted. She didn’t dare to walk fast, she didn’t dare to travel far, she didn’t dare to drink water, she didn’t dare to live alone, and she couldn’t even lie down at night. Under the shadow of the disease, Aunt Liu’s family frowned. The doctor of the local hospital came to Professor Xiang Meixiang’s clinic under the recommendation of the doctor.
Aunt Liu suffers from heart failure, referred to as “heart failure”. Heart failure, as the name suggests, is the decline of cardiac contractility, which is a severe and advanced stage of various cardiovascular diseases. The heart cannot effectively pump blood, causing chest tightness, dyspnea, decreased activity endurance, dizziness, fatigue, oliguria, edema, abdominal distension, Complex and varied symptoms such as decreased appetite. Heart failure has many disgusting nicknames – “cancer” in heart disease, “last battlefield” in heart disease… These nicknames fully reflect the two major characteristics of heart failure: First, the condition is critical and the prognosis is poor. For example, the 5-year survival rate is only 34%, which is almost equal to that of malignant tumors. When the EF is less than 35%, the risk of sudden death is high. Second, it is difficult to cure, and it is easy to lead to repeated hospitalization. blow.
With the acceleration of population aging in my country, the number of patients with coronary heart disease, hypertension, diabetes, heart valve disease and other diseases has accelerated. The number of heart failure patients is also increasing year by year. After evaluating Aunt Liu’s condition and drug treatment, Professor Xiang Meixiang’s team considered device treatment.
There are two traditional device treatments for heart failure. The first is the implantable cardioverter-defibrillator (ICD) to prevent sudden cardiac death. The timely detection and discharge of malignant arrhythmia can save lives, but it cannot directly improve cardiac function. The second is cardiac resynchronization therapy (CRT), which is commonly known as a “three-chamber pacemaker”. In response to the problem of asynchrony of left and right ventricular contractions in patients with heart failure, the pacemaker is directed to help the left and right ventricles to synchronize in a normal order. contraction, so that the heart function is improved, the heart gradually returns to normal size, the heart function is improved or even returns to the normal level, and the life expectancy of the patient is prolonged. However, according to statistics, only about 30% of heart failure patients are suitable for CRT treatment, and 70% of heart failure patients are not suitable for CRT treatment.
And the advent of cardiac contractility regulation therapy just fills this 70% gap. The implantable cardiac contractility regulator (CCM) is also a small machine similar to a cardiac pacemaker. It is connected to the right ventricular septum through two pacing electrodes to enhance cardiac contractility through electrical stimulation of the absolute refractory period of the myocardium. Pumping more blood, improving heart function and prolonging the life of patients is called “black technology”. CCM was named one of the “most advanced device therapies for heart failure” by the American College of Cardiology in 2021.
Aunt Liu’s EF value was only 23.4%, but she was not eligible for CRT treatment. In this regard, Professor Xiang Meixiang’s team considered the CCM+ICD scheme after comprehensive analysis, which can not only protect life, but also improve cardiac function. Ms. Liu and her family happily decided to seize this life-saving straw and became the first patient in Zhejiang Province to receive CCM implantation.
On the morning of April 28, Professor Xiang Meixiang’s team implanted a cardiac contractility regulator for Aunt Liu. The operation was performed under local anesthesia, and the patient was awake the whole time, and the implantation was successfully completed in about 1 hour. Just 1 hour after CCM implantation, Aunt Liu’s cardiac function experienced immediate and gratifying changes, with significantly enhanced contractility and significantly improved left ventricular ejection fraction. Over time, CCM will further improve the patient’s cardiac function.
All of this is like a beam of sunshine, shining into the haze that has been entrenched in Aunt Liu’s heart for a long time, and also rekindling her hope in life. “I must take the medicine well, cooperate with the doctor’s orders, return to the clinic on time, and maintain the victory!” The application of CCM in China has just started, filling the gap in the field of chronic heart failure device treatment in China. The clinical application of CCM will surely benefit more heart failure patients and bring new hope to heart failure patients.
Author: Liu Haibo, Zhu Junjun, Ding Siyin
Editor: Fu Xinxin
Responsible Editor: Jiang Ping
*Wenhui Exclusive Manuscripts, reprint please indicate the source.